Digestive Care

Endoscopic Retrograde Cholangiopancreatography

ERCP is a procedure used to either diagnose or treat many diseases of the pancreas, bile ducts, liver and gallbladder. Diagnostic ERCP can help determine the cause of the signs or symptoms the patient may be experiencing such as:

· Jaundice (or yellow discoloration of the eyes and skin).
· Abdominal pain suggesting biliary or pancreatic disease.
· Abnormal laboratory tests.

ERCP can be used to determine if surgical intervention is necessary.

Therapeutic ERCP can open the end of the bile duct, remove stones and improve drainage by placing stents (plastic drainage tubes) across obstructed ducts.

Preparation Before the Procedure
Preparation After the Procedure
Day of the Procedure
Expectation After the Procedure
Possible Complications

Preparation Before the Procedure:
It is important to have a completely empty stomach for the best possible examination. You should not eat or drink for at least six hours (and preferably overnight) before the procedure. An allergy to iodine-containing drugs (contrast material or "dye") doesn't automatically prevent someone from undergoing ERCP, but it should be discussed with your physician prior to the procedure. The physician performing the procedure should be informed of any medications that you take regularly, any heart or lung conditions (or any other major diseases) and whether you have any drug allergies.

It is important for you to tell your doctor several days prior to the examination if you take prescription or over- the-counter drugs and if you have any allergies. Be sure to discuss with the physician whether you should adjust any of your usual medications before the procedure.

You should alert your doctor prior to procedure if you have conditions that require antibiotics, such as mitral valve prolapse and heart prosthesis. Be sure to discuss with the physician if you have question or think you are pregnant or you are of childbearing age, because X-ray films or scans may be taken during procedure.

Your doctor will discuss with you the reason for performing the procedure, whether alternative tests or procedures are available, and any possible risks and complications. [Back to the top]

Preparation After the Procedure:
Because of the aftereffects of the anesthetic agents or sedatives used during procedure, it is important that you make arrangement for someone to drive you home. For your safety, you will be told to refrain from the following activities for at least 12 to 16 hours:

· Driving any vehicle or operating machinery, because your reflexes and coordination are altered.
· Operating any motorized or non-motorized vehicles or modes of transportation on the day of the procedure.
· Going anywhere but home after being discharged from the hospital.
· Returning to work on the day of the procedure.
· Consuming alcohol or using recreational drugs on the day of the procedure.
· Operating appliances (i.e., stove, iron, lawn mower) on the day of the procedure.
· Signing any important papers or making any important decisions on the day of the procedure.

You may need to make arrangements for home supervision following the procedure.

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Day of the Procedure:
A local anesthetic (numbing agent) may be applied to your throat and an intravenous sedative may be given to make you more comfortable during the test. Some patients also receive antibiotics before the procedure. You will be lying on your belly for the procedure. A long, flexible duodenoscope (with an open channel) is passed through the mouth, esophagus, stomach and through the duodenum (the first portion of the small intestine). When the papilla of Vater (a small structure with openings leading to the bile ducts and the pancreatic duct) is identified, a cannula (small plastic catheter) is passed through an open channel of the duodenoscope into the papilla of Vater, and into the bile ducts and/or the pancreatic duct. A dye is injected and X-rays are taken of the bile ducts and the pancreatic duct. Depending on the condition and the problem of the patient, a highly specialized physician can pass through instruments into the open channel of the endoscope and perform:

· Biopsies.
· Relief of obstructed bile ducts caused by stones, sludge and abnormal mass or scarring.
· Incision by using electrocautery (electric heat).

You may want to ask your doctor questions specific to your medical situation.

The scope does not affect your ability to breath. Air is introduced through the scope and may cause temporary bloating during and after the procedure. The injection of contrast material (dye) into the ducts rarely causes discomfort. [Back to the top]

What Are Possible Complications of ERCP?
ERCP is generally safe when performed by physicians who have been specially trained and are experienced in endoscopic procedures. However, all of the below complications are possible. Your doctor will discuss their frequency with you, if you desire. Ask your doctor if you have any unanswered question about the procedure.

· Pancreatitis: Inflammation of the pancreas.
· Infection: Infection of the bile ducts.
· Bleeding: May occur as a complication of biopsy. It is usually minor and stops on its own or can be controlled during procedure.
· Perforation or tear: Passage of the instrument may result in an injury to the gastrointestinal tract wall with possible leakage of gastrointestinal contents into the body cavity. If this occurs surgery to close the leak and/or drain the region is usually required.
· Drug reactions: It is extremely important that you inform your doctor of all the medications that you are taking including prescriptions and over the counter drugs and of all your allergic tendencies.
· Medication phlebitis: Medications used for sedation may irritate the vein in which they are injected. This causes a red, painful swelling of the vein and surrounding tissue. Discomfort in the area may persist for several weeks, but this will go away eventually.

Although ERCP has a low incidence of complications, it is important for you to recognize early signs of any possible complication. Contact the physician who performed the ERCP immediately if you notice any of the following signs or problems: severe abdominal pain, fever and chills or bleeding. In case of complication, patient may need to be hospitalized and surgery is rarely required. [Back to the top]

What to Expect After the Procedure:
After the procedure, you will be monitored for about one to four hours in the GI lab or endoscopy area. Evidence of any complications of the procedure will be looked for and possible hospitalization may be advised if further observation is necessary.

In most cases, your doctor can tell you the results the day of the procedure; however, results may take several days if samples for biopsy or cytology were taken during procedure.

You may have some cramping or bloating because of the air introduced during the procedure. This should disappear quickly with passage of flatus (gas). Your physician or nurse will provide you with diet and activity instructions.  [Back to the top]